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What is Monitored Anesthesia Care?
Monitored anesthesia care (MAC)
is a specific type of anesthesia service wherein an
anesthesiologist is requested to participate in the care of
a patient who is undergoing a diagnostic or therapeutic
procedure.
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Effects of Monitored Anesthesia Care
MAC provides the patient with anxiety relief, amnesia, pain
relief, comfort, and safety during the entire procedure.
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Candidates for Monitored Anesthesia
Care
MAC is ideal for patients undergoing uncomfortable
procedures and minor surgeries that do not require the use
of general anesthesia. Sometimes, MAC is solely used for
non-painful procedures and often to supplement local
anesthetic injections for painful ones.
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Your
Consultation
The
anesthesiologist will interview the patient about his
general health before starting the procedure. The patient
will be asked about his current medical history,
medications, allergies, and past medical, surgical and
anesthetic information. The patient should also prepare his
old medical records and lab tests in case these are needed.
The doctor will give the patient instructions for taking
medications, restrictions on eating and drinking prior to
the procedure.
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The Monitored Anesthesia Care
Procedure
On the day of the procedure, the patient will receive
medications through an intravenous line (IV) and the
anesthesia care provider may give the patient a sedative
before entering the operating suite. Inside the operating
suite, monitors will be placed on the patient to assess his
vital signs (blood pressure, heart rate and rhythm,
oxygenation and respiration). Also, supplemental oxygen may
be given if indicated. More sedation is given and then the
procedure begins.
The anesthesia care provider will select the appropriate
medication depending on the type of procedure and the
medical condition of the patient. Local anesthetics are
usually given as local injections or as nerve blocks by the
surgeon or anesthesiologist. The injections used with local
anesthesia will create numbness at the surgical site and
provide pain relief.
The
effect of MAC may range from a mild sedation to a deeper
sleep. With MAC, the patient may or may not wake up from
time to time during the procedure when he is stimulated.
Either he may or may not remember the experience but he
should remain comfortable throughout the entire procedure.
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Recovery
The recovery period of the patient depends on the type and
length of procedure and on the kind of sedation employed.
The patient’s overall tolerance to anesthetic agents and the
ability to metabolize these chemicals for excretion from the
body are other factors to be considered. Also, the
concomitant use of other pharmaceutical agents and body
habitus can affect the rate of anesthetic metabolism and
overall tolerance to these agents.
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Risks
Some side effects from anesthetic medications may include
prolonged sedation, agitation, confusion, nausea, vomiting
and respiratory depression.
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Frequently Asked
Questions
Q:
What happens during monitored anesthesia care?
A:
The
monitored anesthesia care method normally involves the
administration of intravenous anesthetic drugs, oxygen
(given with a nasal cannula or face mask), and standard
patient monitoring procedures like those used during a
general anesthesia. MAC implies that the trachea is not
intubated. Since MAC usually entails the administration of
lower doses of anesthetic drugs compared to general
anesthetic, the recovery period tends to be shorter. The
drugs used can definitely affect the patient’s ability to
remember the procedure, but periods of awareness can occur.
Q:
What is the state of the patient during MAC?
A:
A patient
under MAC is sedated and amnestic but remains responsive
when stimulated to do so. The patient is in a light sleep
and may or may not wake up from time to time during the
procedure even if he does not recall doing so. The patient
is able to breathe on his own and ventilation is not
assisted. The patient is usually awake at the end of the
procedure and can promptly be discharged from the recovery
room. When a patient is undergoing a procedure with MAC, he
is evaluated and monitored in the same manner as if he is
having any other form of anesthesia.
Q:
What are the advantages of this procedure?
A:
IV
sedation is a good middle ground between local anesthesia
(the patient is awake) and general anesthesia (the patient
is asleep). This is sometimes preferred more than general
anesthesia because patients have quick recovery with less
nausea and vomiting. And unlike general anesthesia, the
dosage of the twilight anesthesia can be limited to a level
that allows the patient to respond to verbal commands and
move with assistance. This would be especially helpful when
the surgeon wants to see what the operative area would look
like in a sitting or standing position, or with contraction
of particular muscles (a technique commonly used with
liposuction, breast surgery and facelift surgery).
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